OBJECTIVES: To assess the cost-effectiveness of collagenase enzymatic debridement relative to hydrogel autolytic debridement for pressure ulcers in a long-term care setting. METHODS: A 2-stage Markov model was used to determine the expected costs of wound debridement between collagenase and hydrogel dressings for pressure ulcers in a long-term care setting. The two Markov states used in the analysis were a necrotic non-viable wound bed and a debrided viable wound bed. Outcome data used in the analysis were taken from a randomized clinical trial that directly compared collagenase and hydrogel dressings in a long-term care nursing facility. The primary outcome in the clinical trial was the proportion of patients achieving a viable, granulated wound bed at 42 days. Transition probabilities for the Markov states were estimated from the clinical trial. Resource utilization was based on the wound care treatment regimen used in the clinical trial. Resource utilization costs were derived from standard cost references and medical supply wholesalers. All costs are expressed in 2010 U.S. dollars. The payer perspective was taken in the economic analysis and no cost discounting was performed due to the short time horizon of the study. One-way and probabilistic sensitivity analyses were performed to establish the robustness of the economic results. RESULTS: The clinical trial established that 85% of the collagenase subjects versus 29% of the hydrogel subjects achieved a debrided wound bed at the 42-day assessment. The economic analysis indicated that 42 days after initiating treatment the cost-effectiveness ratio for collagenase was $85 per debrided day compared to $184 per debrided day using a hydrogel dressing. One-way and probabilistic sensitivity analyses indicated that the results were robust within the modeled parameters. CONCLUSIONS: Results indicate that collagenase ointment is cost effective for the debridement of pressure ulcers compared to autolysis with a hydrogel dressing.